{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   M GOMEZ","gend":1,"add":"2 MONTAGUE AVENUE","city":"WINCHESTER                    ","state":"VA","zip":"22601-4424","dob":"2002-11-09","age":"","mstatus":"","insh":4363232,"cliId":"","pno":5403036709,"cno":"","email":"","ename":"","eno":"","pphy":"KORNREICH, BRYAN A","ppno":5406623853,"pcpadd":"1002 Amherst St,Ste C","pcpcity":"Winchester                    ","pcpstate":"VA","pcpzip":226013323,"pcpcounty":"","pcpid":"","pcpname":"PEDIATRIC ASSOCIATES OF WINCHESTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"2 MONTAGUE AVENUE","add3":"","madd1":"2 MONTAGUE AVENUE","madd2":"","madd3":"","mcity":"WINCHESTER                    ","mstate":"VA","mzip":"22601-4424","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H65.03","Z20.828","Z23","Z03.818","B34.9","R51.9","R10.13","R07.9","Z53.21","J06.9","Z20.822","F33.2","R45.851","F60.9","F43.10","J45.909","Z62.820","Z62.810","Z87.440","Z91.5","Z81.8","F34.1","R07.89","R58","F29","R10.2","N92.6","Z11.3","R30.0","R39.9","N89.8","N76.0","F41.9","Z32.02","N94.6","Z30.011","R07.2","R11.2","R06.02","R42","R05.9","F32.A","F43.25","Z91.52","Z91.410"],"date":["2020-08-17","2020-08-17","2020-10-12","2020-12-16","2020-12-16","2021-12-05","2020-12-16","2021-12-06","2021-09-05","2021-09-07","2021-12-16","2021-09-20","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-10-08","2021-09-16","2021-09-16","2021-09-16","2021-12-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-10-11","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-10-08","2021-10-08","2021-10-11","2021-10-11","2021-12-05","2021-12-05","2021-12-06","2021-12-05","2021-12-05","2021-12-16","2021-12-17","2021-12-16","2021-12-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","16714040604","LARIN","TAB 43831","28","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","12","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00093406701","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","14","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}